NPI | 1659307007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 21254) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 21254) |
Enumeration Date | 2006-06-25 |
Last Update Date | 2021-06-09 |