| NPI | 1225001993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 288256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1262) |
| 207Q00000X Family Medicine (Licence: NE 447) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2012-731) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2019-02-11 |