| NPI | 1326425984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1067) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2018-06-12 |