| NPI | 1710966288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 18514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 38713-020) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-04-08 |