| NPI | 1922307974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 006010) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2024-03-08 |