| NPI | 1992758726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 006470) |
| 207Q00000X Family Medicine (Licence: IN 02002157) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-03-07 |