| NPI | 1013911031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17632) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 02001180) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2024-04-01 |