| NPI | 1619032794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 233099) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MT188432) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ 25MA08102000) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-07-26 |