| NPI | 1497920177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0072058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 149202) |
| 207Q00000X Family Medicine (Licence: MD D0072058) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2012-05-14 |