| NPI | 1770802746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A138271) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A138271) |
| 208000000X Pediatrics (Licence: CA A138271) | |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2017-10-13 |