| NPI | 1457595258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102203559) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T9755) |
| 207Q00000X Family Medicine (Licence: TX T9755) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2022-09-26 |