| NPI | 1215931605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0053271) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.123546) |
| 207Q00000X Family Medicine (Licence: UT 8826135-1205) | |
| 207Q00000X Family Medicine (Licence: FL ME173382) | |
| 207Q00000X Family Medicine (Licence: ID M-12235) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-28431) | |
| 207Q00000X Family Medicine (Licence: HI MD-17467) | |
| 207Q00000X Family Medicine (Licence: NH 34313) | |
| 207Q00000X Family Medicine (Licence: KY 60528) | |
| 207Q00000X Family Medicine (Licence: SD 11059) | |
| 207Q00000X Family Medicine (Licence: MO 2013042132) | |
| 207Q00000X Family Medicine (Licence: DE C1-0027803) | |
| 207Q00000X Family Medicine (Licence: OK 30329) | |
| 207Q00000X Family Medicine (Licence: MI 4301513466) | |
| 207Q00000X Family Medicine (Licence: CO DR.0053188) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2026-02-10 |