| NPI | 1487691564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 236352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236352) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-12-09 |