| NPI | 1295799211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD156092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD423476) |
| 207Q00000X Family Medicine (Licence: OR MD156092) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD423476) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-03-02 |