NPI | 1437132859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 50399) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0050399) |
207QS0010X Family Medicine, Sports Medicine (Licence: NC 200301159) | |
Enumeration Date | 2005-11-21 |
Last Update Date | 2019-02-11 |