| NPI | 1336192442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 24070) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-07-21 |