| NPI | 1326191594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 10620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-03320) |
| 207Q00000X Family Medicine (Licence: MI 4301509949) | |
| 207Q00000X Family Medicine (Licence: MN 73299) | |
| 207Q00000X Family Medicine (Licence: GA 94160) | |
| 207Q00000X Family Medicine (Licence: CO DR.0069934) | |
| 207Q00000X Family Medicine (Licence: IN 01090947A) | |
| 207Q00000X Family Medicine (Licence: CT 45064) | |
| 207Q00000X Family Medicine (Licence: OH 35.147254) | |
| 207Q00000X Family Medicine (Licence: NY 320281) | |
| 207Q00000X Family Medicine (Licence: VA 0101277045) | |
| 207Q00000X Family Medicine (Licence: WA MD61369999) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-11-26 |