| NPI | 1194133041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A13692) |
| 207Q00000X Family Medicine (Licence: AZ 008447) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-05-24 |