NPI | 1023194016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 37464) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 38868) |
Enumeration Date | 2006-10-31 |
Last Update Date | 2007-07-08 |