| NPI | 1023115383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME064738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0064738) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-10-15 |