| NPI | 1740311208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 031959) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 31959) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CT 31959) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CT 031959) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CT 031959) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-12-31 |