| NPI | 1356751838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 301612) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25ma10398000) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2020-01-22 |