| NPI | 1992117162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NJ 25MA11286800) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: NY 292229) |
| 207QS0010X Family Medicine Sports Medicine (Licence: FL ME157308) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-04-10 |