| NPI | 1659664191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 51738) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2019-05-14 |