| NPI | 1295799591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD422543) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD422543) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2013-01-15 |