| NPI | 1518452911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T1360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10064479) |
| 207Q00000X Family Medicine (Licence: TX T1360) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-10-14 |