| NPI | 1497195697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02004818A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004818A) |
| 207Q00000X Family Medicine (Licence: KY 04316) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2020-12-03 |