| NPI | 1508973165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: IN 36000176A) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IN 36000176A) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |