| NPI | 1205997665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2829) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 0639) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-10-20 |