| NPI | 1821258062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NH 16235) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: ME 2237) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2017-02-23 |