| NPI | 1134173701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35083945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39733) |
| 207Q00000X Family Medicine (Licence: NM MD2005-0521) | |
| 207Q00000X Family Medicine (Licence: NC 2005-01654) | |
| 207Q00000X Family Medicine (Licence: OR MD26041) | |
| 207Q00000X Family Medicine (Licence: NV 12288) | |
| 207Q00000X Family Medicine (Licence: WA MD00047593) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-04-26 |