| NPI | 1902965601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: MI 4301054402) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301054402) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-12-21 |