| NPI | 1396310728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101279334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.48058) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2024-12-30 |