| NPI | 1790406213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0105661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2022027016) |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2026-04-29 |