NPI | 1942526686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A113395) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A113395) |
Enumeration Date | 2010-04-19 |
Last Update Date | 2020-03-01 |