| NPI | 1114157112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D80127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 269088) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 269088) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MD D80127) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2024-03-25 |