| NPI | 1669426219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB07964500) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS-010745-L) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-02 |