| NPI | 1548537723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A055186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD201160) |
| 207Q00000X Family Medicine (Licence: TX T8427) | |
| 207Q00000X Family Medicine (Licence: AZ 67325) | |
| 207Q00000X Family Medicine (Licence: ID MC-1495) | |
| 207Q00000X Family Medicine (Licence: MT 113327) | |
| 207Q00000X Family Medicine (Licence: UT 12894174-1205) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0001830) | |
| 207Q00000X Family Medicine (Licence: WA MD61082986) | |
| 207Q00000X Family Medicine (Licence: NV 22403) | |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2023-06-22 |