| NPI | 1023010592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA L022840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-50271) |
| 207Q00000X Family Medicine (Licence: AR E-18377) | |
| 207Q00000X Family Medicine (Licence: WI 84338-20) | |
| 207Q00000X Family Medicine (Licence: OH 35.152204) | |
| 207Q00000X Family Medicine (Licence: IL 036167418) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2026-03-04 |