| NPI | 1336291095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 3655076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 31368) |
| 207Q00000X Family Medicine (Licence: CT 041856) | |
| 207Q00000X Family Medicine (Licence: KY 38323) | |
| 207Q00000X Family Medicine (Licence: NV RL226) | |
| 207Q00000X Family Medicine (Licence: NC 200300930) | |
| 207Q00000X Family Medicine (Licence: OK 23684) | |
| 207Q00000X Family Medicine (Licence: OR MD24460) | |
| 207Q00000X Family Medicine (Licence: VA 0101235644) | |
| 207Q00000X Family Medicine (Licence: MS 18122) | |
| 207Q00000X Family Medicine (Licence: WI 50229-20) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-01-25 |