| NPI | 1629692769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.3309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS PRIN-CYGCZT) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-07-01 |