| NPI | 1265490205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L2341) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX L2341) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NV 15834) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2016-07-29 |