NPI | 1114112067 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA md435036) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD435036) |
Enumeration Date | 2007-09-12 |
Last Update Date | 2024-11-25 |