| NPI | 1184745952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA MD208145) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD441388) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 259369) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2015-12-30 |