| NPI | 1912358862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-45850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016020822) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2019-07-23 |