NPI | 1295931962 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 63808) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD427827) |
207QS0010X Family Medicine, Sports Medicine (Licence: PA MD427827) | |
Enumeration Date | 2007-06-21 |
Last Update Date | 2018-06-21 |