| NPI | 1033287594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 259717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 259717) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2019-05-24 |