| NPI | 1326273392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD439686) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD439686) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2013-02-21 |