| NPI | 1841725108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 72971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 72971) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 72971-20) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2022-01-18 |