| NPI | 1508867672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101034109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 31285) |
| 207Q00000X Family Medicine (Licence: WI 38697) | |
| 207Q00000X Family Medicine (Licence: SC 19181) | |
| 207Q00000X Family Medicine (Licence: UT 339571-1205) | |
| 207Q00000X Family Medicine (Licence: CA G084432) | |
| 207Q00000X Family Medicine (Licence: AZ 26099) | |
| 207Q00000X Family Medicine (Licence: VT 420009595) | |
| 207Q00000X Family Medicine (Licence: WA 00035725) | |
| 207Q00000X Family Medicine (Licence: CO 37054) | |
| 207Q00000X Family Medicine (Licence: NM 99-44) | |
| 207Q00000X Family Medicine (Licence: WY 6222A) | |
| 207Q00000X Family Medicine (Licence: MN 42646) | |
| 207Q00000X Family Medicine (Licence: MD D56565) | |
| 207Q00000X Family Medicine (Licence: ID M-8300) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-09 |