NPI | 1568709244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 289489) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 289489) |
Enumeration Date | 2013-01-15 |
Last Update Date | 2024-06-24 |