| NPI | 1689011272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131373) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME131373) |
| 207Q00000X Family Medicine (Licence: PA MD455732) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2019-07-29 |