| NPI | 1609160019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12875) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2021-10-04 |