| NPI | 1922095769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 01037755A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01037755A) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-06-15 |