| NPI | 1013186964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 100993) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2024-10-16 |