| NPI | 1447612361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO3070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A18070) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-05-02 |