| NPI | 1003894320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 345) |
| 207Q00000X Family Medicine (Licence: NM A-1686-12) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2018-03-12 |