| NPI | 1669496469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 237430) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB07982100) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-03-21 |