| NPI | 1083717565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME108274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-02167) |
| 207Q00000X Family Medicine (Licence: WV 24750) | |
| 207Q00000X Family Medicine (Licence: OH 35.043934) | |
| 207Q00000X Family Medicine (Licence: SC 37406) | |
| 207Q00000X Family Medicine (Licence: VA 0101256861) | |
| 207Q00000X Family Medicine (Licence: GA 072607) | |
| 207Q00000X Family Medicine (Licence: TN 51945) | |
| 207Q00000X Family Medicine (Licence: NH 16754) | |
| 207Q00000X Family Medicine (Licence: KY 47505) | |
| 207Q00000X Family Medicine (Licence: DC MD042677) | |
| 207Q00000X Family Medicine (Licence: AR E-10326) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2023-01-19 |