| NPI | 1174086664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO3474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV FR3405950) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-12-19 |