| NPI | 1649839259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 21485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV LL3289) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2023-04-17 |