| NPI | 1285872143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N4175) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A10471) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2011-03-04 |