| NPI | 1891109039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 72217) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01080150A) |
| 207Q00000X Family Medicine (Licence: ID MRM-1386) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2021-05-04 |