| NPI | 1932428232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8996269-1205) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 8996269-1205) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2020-03-30 |