| NPI | 1427312297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044084) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX Q6520) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2016-09-06 |