| NPI | 1538387964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 286279) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME 126965) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2019-09-25 |