| NPI | 1275556904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60488723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE NE229) |
| 207Q00000X Family Medicine (Licence: SD 7914) | |
| 207Q00000X Family Medicine (Licence: MT MT28430) | |
| 207Q00000X Family Medicine (Licence: WY 9500A) | |
| 207Q00000X Family Medicine (Licence: ID O-0812) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-09-28 |