| NPI | 1598184756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 286419) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 286419) |
| 207Q00000X Family Medicine (Licence: NY 286419) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-02-11 |