| NPI | 1306046446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX P0185) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: OH 009582) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2020-09-10 |