NPI | 1255504254 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11603) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT 11603) |
208D00000X General Practice (Licence: MT 11603) | |
207QS0010X Family Medicine, Sports Medicine (Licence: MT 11603) | |
Enumeration Date | 2008-04-10 |
Last Update Date | 2010-02-05 |