| NPI | 1841619418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA10430800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60478159) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2018-10-11 |