| NPI | 1386909851 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-12656) |
| 207Q00000X Family Medicine (Licence: NV 18519) | |
| 207Q00000X Family Medicine (Licence: PA MD479943) | |
| 207Q00000X Family Medicine (Licence: WA MD60824368) | |
| 207Q00000X Family Medicine (Licence: UT 8736463-1205) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2025-09-10 |