| NPI | 1356679138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0076580) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0076580) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2025-10-07 |