| NPI | 1578805354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260449) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2022-07-21 |