| NPI | 1790170207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S1688) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: TX S1688) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2022-04-28 |