| NPI | 1194994210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC TL1618) |
| 207Q00000X Family Medicine (Licence: TX M8253) | |
| 207Q00000X Family Medicine (Licence: CO 47984) | |
| 207Q00000X Family Medicine (Licence: NC 2022-03210) | |
| 207Q00000X Family Medicine (Licence: KS 05-48528) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NC 2022-03210) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: SC 1618) | |
| 208000000X Pediatrics (Licence: SC 1618) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2023-11-16 |