NPI | 1760831028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL DO2331) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2019-01187) |
Enumeration Date | 2016-06-08 |
Last Update Date | 2024-02-08 |