| NPI | 1376920116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.158731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205424) |
| 207Q00000X Family Medicine (Licence: TX R9788) | |
| 207Q00000X Family Medicine (Licence: RI DO00936) | |
| 207Q00000X Family Medicine (Licence: NC 2018-02445) | |
| 207Q00000X Family Medicine (Licence: MA 277496) | |
| 207Q00000X Family Medicine (Licence: CA 15597) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2023-05-25 |