| NPI | 1467593715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME104257) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-10-20 |