| NPI | 1437162864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS004244L) |
| 207Q00000X Family Medicine (Licence: CA 20A12513) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2013-08-26 |