NPI | 1376722124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101242650) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101242650) |
Enumeration Date | 2007-10-29 |
Last Update Date | 2020-10-05 |