| NPI | 1255746731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO1878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021401) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2018-09-26 |