| NPI | 1093205510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1334) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-06-24 |