| NPI | 1831117035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD069596L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08652900) |
| 207Q00000X Family Medicine (Licence: PA MD069596L) | |
| 207Q00000X Family Medicine (Licence: NY 307191-01) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-03-08 |