| NPI | 1073176392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-48972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11449) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2022-09-25 |