| NPI | 1578683223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO CDRH.0053122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0053122) |
| 207Q00000X Family Medicine (Licence: IA MD-45754) | |
| 207Q00000X Family Medicine (Licence: AZ 57589) | |
| 207Q00000X Family Medicine (Licence: ME MD22717) | |
| 207Q00000X Family Medicine (Licence: MN 64736) | |
| 207Q00000X Family Medicine (Licence: WA MD60913138) | |
| 207Q00000X Family Medicine (Licence: WI 281-320) | |
| 207Q00000X Family Medicine (Licence: NV 18414) | |
| 207Q00000X Family Medicine (Licence: UT 11037807-1205) | |
| 207Q00000X Family Medicine (Licence: KS 04-41643) | |
| 207Q00000X Family Medicine (Licence: SD 11383) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2019-09-10 |