| NPI | 1588697544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD DOO50882) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2019-03-13 |