| NPI | 1770754301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: IN 01066805A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066805A) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2020-12-17 |