| NPI | 1528353992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7643) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2018-09-20 |