| NPI | 1205493962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-49492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11463) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2022-09-25 |