| NPI | 1508081944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 85-178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5678) |
| 207Q00000X Family Medicine (Licence: MT 12183) | |
| 207Q00000X Family Medicine (Licence: WA MD60289657) | |
| 207Q00000X Family Medicine (Licence: ID M-11674) | |
| 207Q00000X Family Medicine (Licence: WY 8991A) | |
| 207Q00000X Family Medicine (Licence: CO DR.0051542) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-01-04 |