| NPI | 1770570616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: IN 01038394A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 010138394A) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2023-09-18 |