| NPI | 1588621890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 14282255-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01058153A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01058153a) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 27691) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2026-06-12 |