| NPI | 1376922450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01091015A) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 01091015A) |
| 208000000X Pediatrics (Licence: IN 01091015A) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2023-09-26 |