| NPI | 1245359132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 28309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 20203) |
| 207Q00000X Family Medicine (Licence: NC 2019-00062) | |
| 207Q00000X Family Medicine (Licence: TN 52174) | |
| 207Q00000X Family Medicine (Licence: AK 126620) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-01-24 |