| NPI | 1104086958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01071171A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT192454) |
| 207Q00000X Family Medicine (Licence: IN 01071171A) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-12-21 |