| NPI | 1922537190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD49916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 078282) |
| 207Q00000X Family Medicine (Licence: IA MD-49909) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2025-02-05 |