| NPI | 1740676907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX R9631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A161921) |
| 207Q00000X Family Medicine (Licence: TX R9631) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A161921) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2024-09-09 |