| NPI | 1154583870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 48288) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2024-08-05 |