| NPI | 1225520059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 325078-01) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 2559) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-08-28 |