| NPI | 1508187360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL0755) |
| 207Q00000X Family Medicine (Licence: AK 7829) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-03-25 |