| NPI | 1043446206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX P4860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10035367) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2019-11-27 |