| NPI | 1255726865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 85586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 65798) |
| 207Q00000X Family Medicine (Licence: DC DO034954) | |
| 207Q00000X Family Medicine (Licence: FL OS16529) | |
| 207Q00000X Family Medicine (Licence: TX S0969) | |
| 207Q00000X Family Medicine (Licence: CO DR.0063414) | |
| 207Q00000X Family Medicine (Licence: CA 18511) | |
| 207Q00000X Family Medicine (Licence: AL 2169) | |
| 207Q00000X Family Medicine (Licence: AK 149901) | |
| 207Q00000X Family Medicine (Licence: AZ 008542) | |
| 207Q00000X Family Medicine (Licence: AR E-13264) | |
| 207Q00000X Family Medicine (Licence: ID OC-0067) | |
| 207Q00000X Family Medicine (Licence: IL 036.151580) | |
| 207Q00000X Family Medicine (Licence: HI DOS2024) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX S0969) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-05-13 |