| NPI | 1841828977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 58351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01091117A) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-12-23 |