NPI | 1851687362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD459798) |
Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: VA 0101255944) |
Enumeration Date | 2011-06-22 |
Last Update Date | 2017-04-18 |