NPI | 1649224635 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2000-00017) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2000-00017) |
Enumeration Date | 2006-05-22 |
Last Update Date | 2013-07-01 |