NPI | 1073923496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017810) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017810) |
207Q00000X Family Medicine (Licence: PA OT015777) | |
Enumeration Date | 2014-05-07 |
Last Update Date | 2022-08-26 |