NPI | 1245291616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 059115) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 92466) |
Enumeration Date | 2006-03-28 |
Last Update Date | 2021-02-15 |