| NPI | 1467831966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 9873516-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9873516-1205) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2019-12-19 |