| NPI | 1992201834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0094214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101272806) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2022-11-17 |