| NPI | 1568615300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 01065871A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME116877) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2016-09-07 |