| NPI | 1255613527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 31278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L3112R) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2023-01-06 |