| NPI | 1871942151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2404) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV DO2404) |
| 207Q00000X Family Medicine (Licence: NV SL1161) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2019-08-09 |