| NPI | 1295114171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME133173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D86787) |
| 207Q00000X Family Medicine (Licence: LA 311985) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA10673900) | |
| 207Q00000X Family Medicine (Licence: PA MD466543) | |
| 207Q00000X Family Medicine (Licence: HI MD-19793) | |
| 207Q00000X Family Medicine (Licence: UT 11567414-1205) | |
| 207Q00000X Family Medicine (Licence: ME MD23563) | |
| 207Q00000X Family Medicine (Licence: OK 35178) | |
| 207Q00000X Family Medicine (Licence: CO DR.0062561) | |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2022-11-03 |