| NPI | 1134656556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 37442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 081224) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2024-01-30 |