| NPI | 1558351668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD-421514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-421514) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2018-03-10 |