| NPI | 1871607119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.3120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203654) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-05-12 |