| NPI | 1497905566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5234046-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 15463) |
| 207Q00000X Family Medicine (Licence: MO 2018043154) | |
| 207Q00000X Family Medicine (Licence: LA 311397) | |
| 207Q00000X Family Medicine (Licence: TX R9884) | |
| 207Q00000X Family Medicine (Licence: AR E-11862) | |
| 207Q00000X Family Medicine (Licence: OK 6563) | |
| 207Q00000X Family Medicine (Licence: CA 20A16954) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2023-08-15 |