| NPI | 1316279326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0619) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX P0619) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX P0619) | |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2024-04-24 |