| NPI | 1356580542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 08720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A70404) |
| 207Q00000X Family Medicine (Licence: CT 040080) | |
| 207Q00000X Family Medicine (Licence: DE C1-0006033) | |
| 207Q00000X Family Medicine (Licence: HI 11849) | |
| 207Q00000X Family Medicine (Licence: KY 36653) | |
| 207Q00000X Family Medicine (Licence: MO 118044) | |
| 207Q00000X Family Medicine (Licence: MT 9902) | |
| 207Q00000X Family Medicine (Licence: NH 11127) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA07091200) | |
| 207Q00000X Family Medicine (Licence: NC 200001571) | |
| 207Q00000X Family Medicine (Licence: ND 8386) | |
| 207Q00000X Family Medicine (Licence: OK 22710) | |
| 207Q00000X Family Medicine (Licence: TN MD12756) | |
| 207Q00000X Family Medicine (Licence: VT 042-0010301) | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |