NPI | 1629334701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5451) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 5451) |
Enumeration Date | 2012-04-03 |
Last Update Date | 2025-09-23 |