| NPI | 1952392532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207803) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: TX F3804) |
| 207Q00000X Family Medicine (Licence: CO 24446) | |
| 207Q00000X Family Medicine (Licence: TX F3804) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: CO 24446) | |
| 207Q00000X Family Medicine (Licence: NM 2014-0048) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NM 2014-0048) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: LA MD.207803) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2015-12-29 |