| NPI | 1578581898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 10478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 266-320) |
| 207Q00000X Family Medicine (Licence: CO CDR.0000222) | |
| 207Q00000X Family Medicine (Licence: IA MD-45711) | |
| 207Q00000X Family Medicine (Licence: IL 036147552) | |
| 207Q00000X Family Medicine (Licence: MN 64674) | |
| 207Q00000X Family Medicine (Licence: WV 28579) | |
| 207Q00000X Family Medicine (Licence: NE 31199) | |
| 207Q00000X Family Medicine (Licence: KS 04-41567) | |
| 207Q00000X Family Medicine (Licence: AZ 57491) | |
| 207Q00000X Family Medicine (Licence: SD 11404) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-10-18 |