| NPI | 1013321892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020028406) |
| 207Q00000X Family Medicine (Licence: HI DOS-1916) | |
| 207Q00000X Family Medicine (Licence: TX U6846) | |
| 207Q00000X Family Medicine (Licence: WI 73427-21) | |
| 207R00000X Internal Medicine (Licence: FL OS20534) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-08-08 |