| NPI | 1982639860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G8111) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: TX G8111) |
| 207RS0010X Internal Medicine Sports Medicine (Licence: TX G8111) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-08-03 |