NPI | 1396066627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08837900) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA08837900) |
Enumeration Date | 2010-06-22 |
Last Update Date | 2014-06-27 |