| NPI | 1386177400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S5256) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2020-0128) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-04-19 |