NPI | 1477815298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016719) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS016719) |
Enumeration Date | 2012-06-08 |
Last Update Date | 2019-11-21 |