| NPI | 1376851451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX U5167) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME128040) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2023-11-27 |