NPI | 1558383406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D68020) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD422043) |
Enumeration Date | 2006-07-23 |
Last Update Date | 2015-10-23 |