| NPI | 1942462072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 18599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25390) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-08-03 |