| NPI | 1043227077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 075674) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101271553) |
| 207Q00000X Family Medicine (Licence: IN 01060950A) | |
| 208D00000X General Practice (Licence: GA 75674) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-01-27 |