| NPI | 1255365276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J2911) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX J2911) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-04-13 |