NPI | 1043708290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX BP10064727) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10064727) |
Enumeration Date | 2018-04-24 |
Last Update Date | 2022-10-13 |