| NPI | 1336734664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 02006896A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 02006896A) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2024-07-11 |