| NPI | 1306378823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: UT 11680858-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11680858-1204) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2020-07-27 |