| NPI | 1578204707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14211477-1205) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 14211477-1205) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2025-04-22 |