| NPI | 1063924868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.2148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L4569R) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2020-06-12 |