| NPI | 1780978205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.32048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN16020) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2024-01-04 |