| NPI | 1184723819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 72138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 72138) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2017-11-09 |