| NPI | 1578556155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO220338) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02001534A) |
| 207Q00000X Family Medicine (Licence: IN 02001534) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2024-09-09 |