| NPI | 1538797188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 81653) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02007374A) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-09-09 |