| NPI | 1568789139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS015116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 296217) |
| 207QS0010X Family Medicine Sports Medicine (Licence: PA OS015116) | |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2024-06-28 |