| NPI | 1609140847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: UT 8164477-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8164477-1204) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2023-06-19 |