NPI | 1871728725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD445070) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD445070) |
Enumeration Date | 2009-05-21 |
Last Update Date | 2023-03-23 |