| NPI | 1659439172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD05458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101017281) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |