| NPI | 1508128455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018326) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OT014455) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2020-08-31 |