| NPI | 1306232004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 307342) |
| 207Q00000X Family Medicine (Licence: CT 67291) | |
| 207Q00000X Family Medicine (Licence: SC MD52277) | |
| 207Q00000X Family Medicine (Licence: MA 288544) | |
| 207Q00000X Family Medicine (Licence: OH 35.144085) | |
| 207Q00000X Family Medicine (Licence: DC MD210001704) | |
| 207Q00000X Family Medicine (Licence: MA 4950) | |
| 207Q00000X Family Medicine (Licence: NC 209821) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2023-12-18 |