| NPI | 1154147965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0097553) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC MD210003174) |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2024-11-26 |