| NPI | 1790070845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101252693) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2020-10-28 |