| NPI | 1295311348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8478627-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO3440) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2024-05-02 |