NPI | 1790280105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 308657) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 308657) |
Enumeration Date | 2018-03-27 |
Last Update Date | 2023-06-29 |