| NPI | 1821389768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017464) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017464) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2016-12-21 |