| NPI | 1629147558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD054467L) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME152618) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08694900) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 308252) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2022-03-08 |