| NPI | 1255449245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-4821) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N6147) |
| 207P00000X Emergency Medicine (Licence: AR E-4821) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX N6147) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-01-17 |