NPI | 1578583928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 35801) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35801) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2024-03-04 |