| NPI | 1285744490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101007766) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101007766) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101007766) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101007766) | |
| 207Q00000X Family Medicine (Licence: MI 5101007766) | |
| 208VP0000X (Licence: MI 5101007766) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101007766) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: MI 5101007766) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2026-02-18 |