NPI | 1326353996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016519) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS016519) |
Enumeration Date | 2010-08-08 |
Last Update Date | 2024-06-06 |