| NPI | 1992745186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 12164) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME89285) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-06-25 |