| NPI | 1336433010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 33564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01075633A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01075633A) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2019-10-15 |