| NPI | 1336572619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 23211) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18587) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2023-08-02 |