| NPI | 1477864585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 20941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO1073) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2020-08-11 |