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 |