NPI | 1447694823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD.37077) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.37077) |
207Q00000X Family Medicine (Licence: GA 077142) | |
Enumeration Date | 2013-04-29 |
Last Update Date | 2024-09-27 |