| NPI | 1053311985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H8070) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX H8070) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2015-01-21 |