NPI | 1023424256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188398) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD188398) |
Enumeration Date | 2014-07-09 |
Last Update Date | 2018-08-08 |