| NPI | 1730329079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08953200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57014489) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2023-08-10 |