| NPI | 1841230547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO-442) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-01-06 |