NPI | 1942512959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 78628) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME127250) |
Enumeration Date | 2010-07-07 |
Last Update Date | 2022-10-04 |