NPI | 1346278264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME67309) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME67309) |
Enumeration Date | 2006-06-29 |
Last Update Date | 2024-06-06 |