| NPI | 1982850756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1605) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL0607) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-10-18 |