| NPI | 1114029931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G8460) |
| 207Q00000X Family Medicine (Licence: AK AA2558) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-08-26 |