| NPI | 1003667833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD H0104930) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102209753) |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2025-10-30 |