| NPI | 1043494032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N3844) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 40756) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2014-09-11 |