| NPI | 1154386886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 24265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 24265) |
| 207Q00000X Family Medicine (Licence: VA 0101270439) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101270439) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2025-04-22 |