| NPI | 1861018129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0101651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046236) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-01-03 |