| NPI | 1972908150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 23869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA op60949403) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2023-07-10 |