| NPI | 1558657080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 72374) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD452208) |
| 207Q00000X Family Medicine (Licence: PA MT198929) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-01-29 |