| NPI | 1023513868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 47663) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: TX 47663) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-10-02 |