| NPI | 1306232541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.4022R) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2020-10-27 |