NPI | 1508206681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301103066) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301103066) |
Enumeration Date | 2013-07-03 |
Last Update Date | 2024-01-08 |