| NPI | 1609802859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S9506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S9506) |
| 207Q00000X Family Medicine (Licence: IN 11013077A) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-04-22 |