| NPI | 1396056834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015781) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB10306200) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CT 53143) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-01-13 |