| NPI | 1740332212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7207) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX BP10057446) |
| 363A00000X Physician Assistant (Licence: 1068202) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-02-21 |