| NPI | 1740844570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 23848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 55639) |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2024-05-10 |