| NPI | 1811931389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY KY02941) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: KY KY02941) |
| 207R00000X Internal Medicine (Licence: WV 3522) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-10-22 |