| NPI | 1013986751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-36432) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36432) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2024-01-21 |