| NPI | 1124367446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.139525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 78250) |
| 207Q00000X Family Medicine (Licence: NJ 25IA12645400) | |
| 207Q00000X Family Medicine (Licence: CO DR.0063581) | |
| 207Q00000X Family Medicine (Licence: GA 104356) | |
| 207Q00000X Family Medicine (Licence: VA 0101256717) | |
| 207Q00000X Family Medicine (Licence: AL MD.51181) | |
| 207Q00000X Family Medicine (Licence: HI MD-25468) | |
| 207Q00000X Family Medicine (Licence: MO 2025017423) | |
| 207Q00000X Family Medicine (Licence: FL ME173506) | |
| 207Q00000X Family Medicine (Licence: IL 036.174655) | |
| 207Q00000X Family Medicine (Licence: PA MD490307C) | |
| 207Q00000X Family Medicine (Licence: MI EMC0007770) | |
| 207Q00000X Family Medicine (Licence: TN 75377) | |
| 207Q00000X Family Medicine (Licence: MD D0104650) | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2025-08-14 |