NPI | 1346407814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 061350) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PR 17300) |
207Q00000X Family Medicine (Licence: FL ME96748) | |
Enumeration Date | 2008-05-21 |
Last Update Date | 2010-05-13 |