NPI | 1427312297 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6520) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044084) |
207QS0010X Family Medicine, Sports Medicine (Licence: TX Q6520) | |
Enumeration Date | 2012-06-27 |
Last Update Date | 2016-09-06 |