| NPI | 1952563280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 7805) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS-1417) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2020-10-10 |