| NPI | 1841879673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A180937) |
| Additional Taxonomies | 2085R0001X (Licence: IN 01100099A) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-08-20 |