NPI | 1295914299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WI 49791) |
Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: WI 49791-021) |
204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WI 49791) | |
Enumeration Date | 2007-10-26 |
Last Update Date | 2023-06-01 |