| NPI | 1720119027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MD D69657) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A87462) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-04-27 |