| NPI | 1003827205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 0000031792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11537017) |
| 207Q00000X Family Medicine (Licence: VA 0101261890) | |
| 207Q00000X Family Medicine (Licence: WA 61023437) | |
| 207Q00000X Family Medicine (Licence: IL 27188) | |
| 207Q00000X Family Medicine (Licence: NY 305209) | |
| 207Q00000X Family Medicine (Licence: OH 35.069231) | |
| 207Q00000X Family Medicine (Licence: SC 84719) | |
| 207Q00000X Family Medicine (Licence: SD 11943) | |
| 207Q00000X Family Medicine (Licence: FL ME144976) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-06-12 |