| NPI | 1154434488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0100827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 243033) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2026-02-17 |