| NPI | 1821248907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08985600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125053230) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD443555) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2016-10-04 |