NPI | 1598022394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01724) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2015-01724) |
Enumeration Date | 2012-04-18 |
Last Update Date | 2016-08-26 |