| NPI | 1902326499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-46696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11044) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2020-04-02 |