| NPI | 1548588833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8560) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX P8560) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2026-01-22 |