| NPI | 1043530165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01070465A) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.122326) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01070465A) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2016-09-14 |