NPI | 1518913847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 23085) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 23085) |
Enumeration Date | 2006-05-26 |
Last Update Date | 2022-04-20 |