| NPI | 1639305246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL DO.1478) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX P0845) |
| 207Q00000X Family Medicine (Licence: TX P0845) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2023-10-25 |