| NPI | 1609845775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: UT 58953691205) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: UT 58953691205) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-06-13 |