| NPI | 1952532988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX Q6440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 42903) |
| 207Q00000X Family Medicine (Licence: VA 0101246205) | |
| Enumeration Date | 2009-08-08 |
| Last Update Date | 2020-02-18 |