| NPI | 1427405869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 217278) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2019-08-01 |