| NPI | 1790873123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ME DO2826) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 058850) |
| 208D00000X General Practice (Licence: IN 02002833A) | |
| 208D00000X General Practice (Licence: TN DO0000001908) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-07-13 |