| NPI | 1083761159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 53903) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2018-06-16 |