NPI | 1023011913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME80751) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME980751) |
Enumeration Date | 2005-05-24 |
Last Update Date | 2025-09-24 |