| NPI | 1851550495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD432526) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME153117) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2022-02-15 |