| NPI | 1134431554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 276754) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA09317900) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2019-03-27 |