| NPI | 1306131370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 3446) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 3446) |
| 207Q00000X Family Medicine (Licence: TN 3446) | |
| 207R00000X Internal Medicine (Licence: TN 3446) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-12-15 |