NPI | 1659355162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 33794) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 33794) |
Enumeration Date | 2005-11-30 |
Last Update Date | 2020-03-10 |