NPI | 1225423809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00918) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2018-00918) |
207QS0010X Family Medicine, Sports Medicine (Licence: NC 2018-00918) | |
Enumeration Date | 2015-04-01 |
Last Update Date | 2023-12-18 |