| NPI | 1043274046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ME EC101036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD41057) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN MD41057) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-10-16 |