| NPI | 1366565376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 41716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000041716) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2026-01-15 |