| NPI | 1578792800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35121488) |
| 207Q00000X Family Medicine (Licence: NC 2018-02908) | |
| 207Q00000X Family Medicine (Licence: CA C141556) | |
| 207Q00000X Family Medicine (Licence: FL ME103387) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2025-01-27 |