NPI | 1942648225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MO 2019045767) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: GA 78396) |
Enumeration Date | 2013-06-10 |
Last Update Date | 2023-10-16 |