| NPI | 1841217858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8115390-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-9562) |
| 207Q00000X Family Medicine (Licence: NV 14222) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-08-24 |