| NPI | 1194089623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV LL2262) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2025-05-23 |