| NPI | 1023424256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188398) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD188398) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-08-08 |