| NPI | 1003862665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD425395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101265180) |
| 207Q00000X Family Medicine (Licence: NC 2018-01263) | |
| 207Q00000X Family Medicine (Licence: DE C1-0007595) | |
| 207Q00000X Family Medicine (Licence: FL ME90097) | |
| 207Q00000X Family Medicine (Licence: GA 080351) | |
| 207Q00000X Family Medicine (Licence: DC MD045867) | |
| 207Q00000X Family Medicine (Licence: SC 51900) | |
| 207Q00000X Family Medicine (Licence: OH 35.132974) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-12-12 |