| NPI | 1972701837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 8304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21286) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2016-06-10 |