| NPI | 1912937665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 200001254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200001254) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 200001254) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2024-07-15 |