| NPI | 1821521394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: IN 02005944A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005944A) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-03-28 |