| NPI | 1043364839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00046265) |
| 207Q00000X Family Medicine (Licence: IN 01068588A) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: IN 01068588A) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2018-01-08 |