| NPI | 1992042378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 264937) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-01115) |
| 207R00000X Internal Medicine (Licence: NY 264937-1) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2014-01115) | |
| Enumeration Date | 2013-01-05 |
| Last Update Date | 2018-01-18 |