| NPI | 1477421337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 11401847-4405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 13824) |
| 208D00000X General Practice (Licence: AZ 334001) | |
| 208D00000X General Practice (Licence: OK 226598) | |
| 208D00000X General Practice (Licence: MT 277639) | |
| 208D00000X General Practice (Licence: WY 58177) | |
| 208D00000X General Practice (Licence: NV 896850) | |
| 208D00000X General Practice (Licence: ID 8771481) | |
| 208D00000X General Practice (Licence: CO 0103716) | |
| 208D00000X General Practice (Licence: KS 53-84973-081) | |
| Enumeration Date | 2025-10-23 |
| Last Update Date | 2026-02-03 |