| NPI | 1003170713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 04039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11016792A) |
| 207Q00000X Family Medicine (Licence: IN 02004559A) | |
| 207Q00000X Family Medicine (Licence: KY 04039) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2021-03-08 |