| NPI | 1114049566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD435873) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT188739) |
| 207Q00000X Family Medicine (Licence: PA MD435873) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2015-06-22 |