| NPI | 1740266972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 054340) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2016-08-04 |