NPI | 1093195398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME130000) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME130000) |
Enumeration Date | 2015-06-02 |
Last Update Date | 2025-08-22 |