| NPI | 1154987139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NV DO3038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO3038) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2025-08-18 |