| NPI | 1972618775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: IN 01062210A) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 36113741) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-04-13 |