| NPI | 1013237502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: UT 8063548-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8063548-1204) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2021-09-09 |