| NPI | 1588993596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD439452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190706) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2015-11-10 |