NPI | 1639558943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018676) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS018676) |
Enumeration Date | 2015-05-20 |
Last Update Date | 2023-10-20 |