NPI | 1417377755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 70608) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 64464) |
207QS0010X Family Medicine, Sports Medicine (Licence: MN 70608) | |
Enumeration Date | 2014-04-25 |
Last Update Date | 2024-05-09 |