NPI | 1093910697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0265) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N0265) |
Enumeration Date | 2007-06-15 |
Last Update Date | 2022-02-07 |