| NPI | 1568487841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101012101) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-10-17 |