| NPI | 1386739449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB07128700) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS012860) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-02-18 |