| NPI | 1437456092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC PA031714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 57463) |
| 207Q00000X Family Medicine (Licence: VA 0110007132) | |
| 207R00000X Internal Medicine (Licence: DC PA031714) | |
| 207R00000X Internal Medicine (Licence: CA 57463) | |
| 207R00000X Internal Medicine (Licence: VA 0110007132) | |
| 363A00000X Physician Assistant (Licence: DC PA031714) | |
| 363A00000X Physician Assistant (Licence: CA 57463) | |
| 363A00000X Physician Assistant (Licence: VA 0110007132) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA031714) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 57463) | |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110007132) | |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2025-03-14 |