| NPI | 1417925249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 6112) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 6112) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NV 6112) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-03-15 |