| NPI | 1215293659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101277584) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01091111A) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-04-19 |