| NPI | 1083681688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L0666) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: TX L0666) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2013-07-09 |