| NPI | 1700911153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0070210) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055367A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01055367A) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2019-12-05 |