| NPI | 1548547243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301098929) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01070384A) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2023-03-07 |