| NPI | 1063765436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANISH MANNAN Owner 317-660-2173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: IN 01062145A) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2013-02-12 |