| NPI | 1033645296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8935) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX r8935) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2021-12-02 |