| NPI | 1730228917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 2667871204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO1711) |
| 207Q00000X Family Medicine (Licence: WY TL4235) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-05-05 |