| NPI | 1346412426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T9647) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2015017078) |
| 208D00000X General Practice (Licence: GA 074284) | |
| 208D00000X General Practice (Licence: NY 297033) | |
| 208D00000X General Practice (Licence: VA 0101244240) | |
| 208D00000X General Practice (Licence: OH 121471) | |
| 208D00000X General Practice (Licence: IL 036139012) | |
| 208D00000X General Practice (Licence: WA 60348545) | |
| 208D00000X General Practice (Licence: KY 46121) | |
| 208D00000X General Practice (Licence: CA 130240) | |
| 208D00000X General Practice (Licence: WI 63117-20) | |
| 208D00000X General Practice (Licence: IN 01075497A) | |
| 208D00000X General Practice (Licence: MI 4301108442) | |
| 208D00000X General Practice (Licence: MO 2019037051) | |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2022-09-30 |