NPI | 1013932144 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 3500021205) |
Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: UT 3500021205) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2007-07-08 |