| NPI | 1467694687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX P4590) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: LA MD.205477) |
| 207QS0010X Family Medicine Sports Medicine (Licence: HI MD 16328) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2023-09-28 |