| NPI | 1265609820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 257849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015228) |
| 207Q00000X Family Medicine (Licence: NY 257849) | |
| 207Q00000X Family Medicine (Licence: NJ 25MB08512300) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS015228) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08512300) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2020-07-09 |