| NPI | 1982845343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 51401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 51401) |
| 207Q00000X Family Medicine (Licence: TX N9502) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2022-08-02 |