| NPI | 1538394317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX N2351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N2351) |
| 207P00000X Emergency Medicine (Licence: TX N2351) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2017-06-01 |