| NPI | 1033172069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD452868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 452868) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA 452868) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-06-10 |