NPI | 1457595258 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102203559) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T9755) |
207Q00000X Family Medicine (Licence: TX T9755) | |
Enumeration Date | 2009-04-23 |
Last Update Date | 2022-09-26 |