NPI | 1285662957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-3759) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR-49601) |
207QS0010X Family Medicine, Sports Medicine (Licence: AR E-3759) | |
Enumeration Date | 2006-06-29 |
Last Update Date | 2015-03-02 |