| NPI | 1598007098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 2138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13320306-1204) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2024-07-22 |