| NPI | 1306097332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB09249700) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013699) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2026-04-27 |