NPI | 1063825792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 286764) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 286764) |
Enumeration Date | 2014-06-10 |
Last Update Date | 2021-08-06 |