| NPI | 1023350147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD459732) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 99078520A) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2017-03-23 |