| NPI | 1487675633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01092609A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME90245) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036-088279) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2024-03-08 |