| NPI | 1104836022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 75390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-02080) |
| 207Q00000X Family Medicine (Licence: VA 0101268274) | |
| 207Q00000X Family Medicine (Licence: SC 18832) | |
| 207Q00000X Family Medicine (Licence: OH 35.14875) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-116119) | |
| 207Q00000X Family Medicine (Licence: GA 84643) | |
| 207Q00000X Family Medicine (Licence: MD D0089037) | |
| 207Q00000X Family Medicine (Licence: TN 60377) | |
| 207Q00000X Family Medicine (Licence: CA C178106) | |
| 207Q00000X Family Medicine (Licence: TX T5390) | |
| 207Q00000X Family Medicine (Licence: DC MD047910) | |
| 207Q00000X Family Medicine (Licence: FL ME142535) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2025-12-19 |