| NPI | 1053774018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.3471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 83891) |
| 207Q00000X Family Medicine (Licence: KY IP1540) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2023-12-19 |