| NPI | 1457640526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0095717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0012323) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2023-01-11 |