| NPI | 1750524757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD443941) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA09357400) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 307130) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2022-02-28 |