| NPI | 1841444759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 7148463-1205) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD154336) | |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2022-04-12 |