| NPI | 1013315001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 24416) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2018-01-16 |