| NPI | 1588718340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 4887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 4887) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-05-23 |