| NPI | 1013095603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD46742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.017835) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: LA MD.017835) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN MD46742) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-03-07 |