| NPI | 1881857159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 302216) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 54467) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MS 22313) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2021-03-25 |