| NPI | 1770069718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01088629A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD21102) |
| 207Q00000X Family Medicine (Licence: IN 01088629A) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2026-04-27 |