| NPI | 1881872828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08601300) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS014263) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2023-03-08 |