| NPI | 1972187730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 25970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351048104) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-09-03 |