| NPI | 1962060814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 0000004954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 4954) |
| 208600000X Surgery (Licence: TN 4954) | |
| 208000000X Pediatrics (Licence: TN 4954) | |
| 207P00000X Emergency Medicine (Licence: TN 4954) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 4954) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 4954) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2026-07-31 |