| NPI | 1770077562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-51288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12083) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-07-28 |