| NPI | 1558403006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16660) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 207261) |
| 207Q00000X Family Medicine (Licence: GA 056636) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-05-07 |