NPI | 1578908794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 072591) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 072591) |
Enumeration Date | 2013-05-01 |
Last Update Date | 2020-08-25 |