| NPI | 1679564330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD060390L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD060390L) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01049328A) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2024-04-12 |