NPI | 1093986697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D81412) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260188) |
207QS0010X Family Medicine, Sports Medicine (Licence: MD D81412) | |
207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101260188) | |
Enumeration Date | 2008-03-22 |
Last Update Date | 2021-07-26 |