| NPI | 1144541756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: HI MD21713) |
| Additional Taxonomies | 2085R0001X (Licence: VA 0101251339) |
| 208D00000X General Practice (Licence: VA 0101251339) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2023-09-12 |