| NPI | 1609192715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL md.33779) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 276897) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2020-09-15 |