| NPI | 1154405009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301407097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 64514) |
| 207Q00000X Family Medicine (Licence: WY 11742C) | |
| 207Q00000X Family Medicine (Licence: WA MD60893797) | |
| 207Q00000X Family Medicine (Licence: CA G158510) | |
| 207Q00000X Family Medicine (Licence: IL 036147324) | |
| 207Q00000X Family Medicine (Licence: NV 18348) | |
| 207Q00000X Family Medicine (Licence: IA MD-46030) | |
| 207Q00000X Family Medicine (Licence: SD 11380) | |
| 207Q00000X Family Medicine (Licence: CO CDRH.0061038) | |
| 207Q00000X Family Medicine (Licence: AZ 57243) | |
| 207Q00000X Family Medicine (Licence: ID MC-0098) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-09-16 |