| NPI | 1417184565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036128437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 274050) |
| 207Q00000X Family Medicine (Licence: PA MD451169) | |
| 207Q00000X Family Medicine (Licence: MN 59857) | |
| 207Q00000X Family Medicine (Licence: WA MD60443124) | |
| 207Q00000X Family Medicine (Licence: AZ 48908) | |
| 207Q00000X Family Medicine (Licence: NM MD2014-0649) | |
| 207Q00000X Family Medicine (Licence: HI MD-17762) | |
| 207Q00000X Family Medicine (Licence: IA MD-42021) | |
| 207Q00000X Family Medicine (Licence: NV 15501) | |
| 207Q00000X Family Medicine (Licence: WI 62999-20) | |
| 207Q00000X Family Medicine (Licence: CO DR.0054560) | |
| 207Q00000X Family Medicine (Licence: CA A131309) | |
| 207Q00000X Family Medicine (Licence: TX Q5343) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA09483100) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2020-03-16 |