| NPI | 1346561412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 75200) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A121260) |
| 208D00000X General Practice (Licence: HI MD-21564) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2025-05-19 |