| NPI | 1912313263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL13320) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-10-18 |