| NPI | 1114364361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 52780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U8573) |
| 207Q00000X Family Medicine (Licence: CO DR.0070875) | |
| 207Q00000X Family Medicine (Licence: WA MD61432846) | |
| 207Q00000X Family Medicine (Licence: MA 1017300) | |
| 207Q00000X Family Medicine (Licence: GA 99028) | |
| 207Q00000X Family Medicine (Licence: NC 2023-02903) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2025-04-17 |