| NPI | 1851495394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 01039790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01039790) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2021-01-27 |