| NPI | 1063675098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 9284594-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO177210) |
| 207Q00000X Family Medicine (Licence: UT 9284594-1204) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-10-01 |