| NPI | 1528119898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX M5642) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX M5642) |
| 207Q00000X Family Medicine (Licence: TX M5642) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2021-12-03 |