| NPI | 1366691644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 11146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 11146) |
| 207Q00000X Family Medicine (Licence: LA MD.07163R) | |
| 208D00000X General Practice (Licence: LA MD.07163R) | |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2021-04-20 |