| NPI | 1114663150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-52039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12444) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2025-09-17 |