NPI | 1538572482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2023-03283) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX R4679) |
Enumeration Date | 2014-06-09 |
Last Update Date | 2024-12-26 |