| NPI | 1255568119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-40151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 34157) |
| 207Q00000X Family Medicine (Licence: TX T0285) | |
| 207Q00000X Family Medicine (Licence: MO 2022037575) | |
| 207Q00000X Family Medicine (Licence: FL ME160380) | |
| 207Q00000X Family Medicine (Licence: UT 13246298-1205) | |
| 207Q00000X Family Medicine (Licence: AZ 68928) | |
| 207Q00000X Family Medicine (Licence: GA 94920) | |
| 207Q00000X Family Medicine (Licence: NM MD2023-0387) | |
| 207Q00000X Family Medicine (Licence: VA 0101279887) | |
| 207Q00000X Family Medicine (Licence: ND 20440) | |
| 207Q00000X Family Medicine (Licence: MN 75637) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0003372) | |
| 207Q00000X Family Medicine (Licence: WI 3676-320) | |
| 207Q00000X Family Medicine (Licence: KS 04-48614) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2025-04-18 |