| NPI | 1881820579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO3622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21785) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2024-05-30 |