| NPI | 1447646302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 05375) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02007067A) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-08-20 |