| NPI | 1194347799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.45302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 0) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-08-04 |