| NPI | 1124608518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN 74799) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 74799) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2024-01554) | |
| 207Q00000X Family Medicine (Licence: NC 2024-01554) | |
| 207Q00000X Family Medicine (Licence: TN 74799) | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2025-11-05 |