| NPI | 1801866447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.32866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 048356) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-03-01 |