NPI | 1316426257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL 11004124) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL 11004124) |
Enumeration Date | 2018-08-10 |
Last Update Date | 2024-01-31 |