| NPI | 1437155751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L4530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L4530) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2024-01-24 |