| NPI | 1811256084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os12983) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2025-01-14 |