NPI | 1790777811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2574) |
Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL OS 12676) |
207Q00000X Family Medicine (Licence: MI 5101009758) | |
Enumeration Date | 2005-08-16 |
Last Update Date | 2022-10-20 |