| NPI | 1073533881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 14422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME93253) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-07-11 |