| NPI | 1558311092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS013025) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013025) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-10-05 |