| NPI | 1528097771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 41783) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01060568A) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2017-06-22 |