| NPI | 1265429179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NY 276638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 14516) |
| 207QS0010X Family Medicine Sports Medicine (Licence: NH 14516) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2017-11-29 |