| NPI | 1588772115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 6713A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 6713A) |
| 207Q00000X Family Medicine (Licence: NE 22927) | |
| 207Q00000X Family Medicine (Licence: NV 11910) | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NV 11910) | |
| 207P00000X Emergency Medicine (Licence: NE 22927) | |
| 207P00000X Emergency Medicine (Licence: NV 11910) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: WY 6713A) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2008-05-08 |