| NPI | 1447458781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 37415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD47413) |
| 207Q00000X Family Medicine (Licence: WA MD60139831) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 37321) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL 37415) | |
| 207R00000X Internal Medicine (Licence: AL 37415) | |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2023-06-29 |