| NPI | 1568054435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 02007525A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-01-08 |