NPI | 1922205541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S6238) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6238) |
Enumeration Date | 2007-06-28 |
Last Update Date | 2020-05-08 |