| NPI | 1811516552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: KY 59629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 59629) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-07-31 |