| NPI | 1720076342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD14169) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD 14169) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2018-03-17 |