| NPI | 1548619356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-46160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID 83720-0058) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2024-02-11 |