| NPI | 1538471313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9267007-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-44396) |
| 207Q00000X Family Medicine (Licence: NV CL0039) | |
| 207Q00000X Family Medicine (Licence: ID OC-0029) | |
| 207Q00000X Family Medicine (Licence: WI 50) | |
| 207Q00000X Family Medicine (Licence: AZ R1817) | |
| 207Q00000X Family Medicine (Licence: AL DO.1932) | |
| 207Q00000X Family Medicine (Licence: MN 66505) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2024-04-15 |