| NPI | 1952568974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08477000) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MD H0072462) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102202824) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS014255) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2014-02-19 |