NPI | 1679612618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 37296) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 37296) |
207QS0010X Family Medicine, Sports Medicine (Licence: AZ 37296) | |
Enumeration Date | 2007-02-06 |
Last Update Date | 2020-01-10 |