NPI | 1073787305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 79909) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2010-00219) |
207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017714) | |
Enumeration Date | 2008-04-17 |
Last Update Date | 2021-02-26 |