NPI | 1538111240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 40697) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 40697) |
Enumeration Date | 2006-05-17 |
Last Update Date | 2014-04-22 |