| NPI | 1811345184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 74216-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01079773A) |
| 208600000X Surgery (Licence: PA MT211396) | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2023-02-01 |