| NPI | 1528097771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 41783) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 41783) |
| 207R00000X Internal Medicine (Licence: TN 41783) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: TN 41783) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2026-07-24 |