| NPI | 1356683049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16524) |
| Additional Taxonomies | 193200000X Multi-Specialty (Licence: NV 16524) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2020-05-22 |