| NPI | 1144583188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB09553700) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018364) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2024-07-30 |