| NPI | 1609957778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 11282296-1205) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01052416a) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2026-05-01 |