| NPI | 1669813952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301103742) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2024-11-18 |