| NPI | 1730383324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7824) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: TX M7824) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-04-27 |