| NPI | 1043478795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2011-00649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS 015988) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 280667-1) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2024-07-29 |