| NPI | 1568703700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 5599) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX Q8566) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2022-11-15 |