| NPI | 1508886474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 1065341A) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01065341A) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-04-27 |