| NPI | 1881770451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MO 2022043202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022043202) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-09-05 |