| NPI | 1912975020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-31746) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-31746) |
| 207Q00000X Family Medicine (Licence: NE 30383) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-09-29 |