| NPI | 1124133681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 41635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01097747A) |
| 207Q00000X Family Medicine (Licence: ID MC-1132) | |
| 207Q00000X Family Medicine (Licence: IL 36.15871) | |
| 207Q00000X Family Medicine (Licence: AR E-16239) | |
| 207Q00000X Family Medicine (Licence: IA MD-50887) | |
| 207Q00000X Family Medicine (Licence: AZ 66591) | |
| 207Q00000X Family Medicine (Licence: CA C187394) | |
| 207Q00000X Family Medicine (Licence: FL ME157284) | |
| 207Q00000X Family Medicine (Licence: CT 74488) | |
| 207Q00000X Family Medicine (Licence: HI MD-24220) | |
| 207Q00000X Family Medicine (Licence: GA 91406) | |
| 207Q00000X Family Medicine (Licence: KS 04-48927) | |
| 207Q00000X Family Medicine (Licence: KY C2833) | |
| 207Q00000X Family Medicine (Licence: AL 45157) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2026-06-09 |