| NPI | 1053848689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO26940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1202) |
| Enumeration Date | 2017-05-14 |
| Last Update Date | 2020-06-26 |