| NPI | 1104156488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME169225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 328118) |
| 207Q00000X Family Medicine (Licence: WY 19077A) | |
| 207Q00000X Family Medicine (Licence: NJ 25ma07662800) | |
| 207Q00000X Family Medicine (Licence: ND 21369) | |
| 207Q00000X Family Medicine (Licence: DE C1-0028866) | |
| 207Q00000X Family Medicine (Licence: KS 04-51634) | |
| 207Q00000X Family Medicine (Licence: OK 43785) | |
| 207Q00000X Family Medicine (Licence: ID 7171082) | |
| 207Q00000X Family Medicine (Licence: NC 2025-04055) | |
| 207Q00000X Family Medicine (Licence: IN 01098046A) | |
| 207Q00000X Family Medicine (Licence: MI 4301515453) | |
| 207Q00000X Family Medicine (Licence: CO DR.0076248) | |
| 207Q00000X Family Medicine (Licence: IA MD-56100) | |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2026-01-20 |