| NPI | 1891890083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 33093) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: AZ 35093) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2021-09-13 |