| NPI | 1265652317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 2076) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: VA 0102201853) |
| 207R00000X Internal Medicine (Licence: TN 2076) | |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2017-02-07 |