| NPI | 1922242676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26368) |
| Enumeration Date | 2009-04-25 |
| Last Update Date | 2023-10-04 |