| NPI | 1437774346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0103252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL84408) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2025-09-08 |