NPI | 1609075878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 4854640-1204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012841) |
2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 20A14182) | |
208D00000X General Practice (Licence: CA 20A14182) | |
Enumeration Date | 2007-07-17 |
Last Update Date | 2020-10-22 |