| NPI | 1134191224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB07991400) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS19264) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.008291) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2024-05-16 |