NPI | 1023437274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101020964) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101020964) |
Enumeration Date | 2014-04-15 |
Last Update Date | 2023-10-17 |