| NPI | 1649596628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL Os12402) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2025-09-24 |