NPI | 1962798611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ME MD20356) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD20356) |
Enumeration Date | 2011-06-21 |
Last Update Date | 2018-05-14 |