NPI | 1467988014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00765) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 2021-00765) |
Enumeration Date | 2017-05-02 |
Last Update Date | 2025-07-08 |