NPI | 1356563969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00166) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2010-00166) |
207QS0010X Family Medicine, Sports Medicine (Licence: SC 28838) | |
Enumeration Date | 2007-05-03 |
Last Update Date | 2010-11-10 |