| NPI | 1164614764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0066218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101241661) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2023-10-26 |