| NPI | 1457844292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018627) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2022-10-17 |