| NPI | 1336101633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 14208538-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002670A) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2025-11-25 |