| NPI | 1194173963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 18031) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS-1824) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2020-03-04 |