| NPI | 1861602476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: SC 34103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 34103) |
| 208000000X Pediatrics (Licence: SC 34103) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-07-20 |