| NPI | 1255319950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D63673) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0063673) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2026-08-20 |