| NPI | 1720196785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 344837-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 344837-1205) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 253843) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-02-21 |