| NPI | 1992966717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08427400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013428) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013428) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-08-13 |