| NPI | 1972152791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO.2441) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2022-11-22 |