| NPI | 1063827715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 13419) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2016-04-12 |