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 |