| NPI | 1265534465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX P1649) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 27644) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2012-10-12 |