NPI | 1710568670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2293) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX 3046123513) |
Enumeration Date | 2021-04-20 |
Last Update Date | 2025-08-19 |