| NPI | 1750418828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 451) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NV 451) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2018-10-10 |