| NPI | 1003297102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0070419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD463890) |
| 207Q00000X Family Medicine (Licence: PA MT208517) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 300074) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2023-06-21 |