| NPI | 1578945507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 85026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301119422) |
| 207Q00000X Family Medicine (Licence: OR MD190064) | |
| 207Q00000X Family Medicine (Licence: TX S0040) | |
| 207Q00000X Family Medicine (Licence: HI MD-20031) | |
| 207Q00000X Family Medicine (Licence: NC 2018-01234) | |
| 207Q00000X Family Medicine (Licence: DC MD210003103) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2024-04-18 |