NPI | 1881629202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ID M-12444) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SD 4025) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2015-04-15 |