NPI | 1154825552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 201902726) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 201902726) |
Enumeration Date | 2018-03-20 |
Last Update Date | 2024-06-28 |