NPI | 1518113646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 56538) |
Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101246016) |
Enumeration Date | 2008-08-08 |
Last Update Date | 2017-06-21 |