| NPI | 1710974902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0067562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101233996) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2023-02-20 |