| NPI | 1144668757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017271A) |
| 207Q00000X Family Medicine (Licence: IA MD-43530) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IA MD-43530) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2022-07-21 |