NPI | 1548799885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD.40754) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.40754) |
Enumeration Date | 2017-06-09 |
Last Update Date | 2024-09-27 |