| NPI | 1427144583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A97249) |
| 207Q00000X Family Medicine (Licence: OR MD162124) | |
| 207Q00000X Family Medicine (Licence: MT 41935) | |
| 207Q00000X Family Medicine (Licence: NM MD2015-0793) | |
| 207Q00000X Family Medicine (Licence: WY 10464A) | |
| 207Q00000X Family Medicine (Licence: NV 16301) | |
| 207Q00000X Family Medicine (Licence: HI MD-18503) | |
| 207Q00000X Family Medicine (Licence: CO DR.0056351) | |
| 207Q00000X Family Medicine (Licence: ID M-13199) | |
| 207Q00000X Family Medicine (Licence: AZ 51068) | |
| 207Q00000X Family Medicine (Licence: AK 113948) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-04-30 |