| NPI | 1467866467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ND 15932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018282A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01080600A) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-10-02 |