| NPI | 1528572542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21038) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01091718A) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2023-12-14 |