| NPI | 1902810732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME119731) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 237567) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-10-15 |