| NPI | 1164083523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1669) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2021-09-16 |