| NPI | 1629567425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TN 71515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 71515) |
| 207Q00000X Family Medicine (Licence: MI 4351044243) | |
| 207Q00000X Family Medicine (Licence: MO 2023024272) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-10-03 |