NPI | 1649891318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 010082) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R3371) |
Enumeration Date | 2020-05-04 |
Last Update Date | 2023-07-12 |