| NPI | 1861452294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: MA 74311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01051636A) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: IN 01051636A) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2011-02-28 |