| NPI | 1346478476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 7747196-1205) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01070960A) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2025-07-18 |