NPI | 1780813444 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-02371) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS 12385) |
Enumeration Date | 2009-07-02 |
Last Update Date | 2020-02-26 |