NPI | 1487794012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: HI MD-2869) |
Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: HI MD-2869) |
208D00000X General Practice (Licence: HI MD-2869) | |
209800000X Legal Medicine (Licence: HI MD-2869) | |
Enumeration Date | 2007-02-06 |
Last Update Date | 2007-07-08 |