| NPI | 1861888570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA OS020141) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016302) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-04-07 |