| NPI | 1639862030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 29241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 37003) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2026-06-16 |