NPI | 1811967235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA 324896) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX K-O568) |
Enumeration Date | 2006-01-26 |
Last Update Date | 2022-04-18 |