| NPI | 1376631077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036128349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 17046) |
| 207P00000X Emergency Medicine (Licence: AZ 4046) | |
| 207Q00000X Family Medicine (Licence: MI 5101020833) | |
| 207Q00000X Family Medicine (Licence: MT 91382) | |
| 207Q00000X Family Medicine (Licence: NH 21116) | |
| 207Q00000X Family Medicine (Licence: RI DO01055) | |
| 207Q00000X Family Medicine (Licence: SD TP343) | |
| 207Q00000X Family Medicine (Licence: VT 162.0000025) | |
| 207Q00000X Family Medicine (Licence: WI 1033) | |
| 207Q00000X Family Medicine (Licence: HI DOS-2138) | |
| 207Q00000X Family Medicine (Licence: ME DO3172) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-05-03 |