| NPI | 1811967235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA 324896) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX K-O568) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-04-18 |