| NPI | 1669176632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301515772) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01098646A) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-12-27 |