NPI | 1750357927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: ME 014426) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 014426) |
Enumeration Date | 2006-02-27 |
Last Update Date | 2019-07-17 |