| NPI | 1598032559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11648) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-44468) |
| 207Q00000X Family Medicine (Licence: NV DO2053) | |
| 207Q00000X Family Medicine (Licence: WY 10498A) | |
| 207Q00000X Family Medicine (Licence: ID O-0956) | |
| 207Q00000X Family Medicine (Licence: CO DR.0057596) | |
| 207Q00000X Family Medicine (Licence: AZ 006843) | |
| 207Q00000X Family Medicine (Licence: NM A-2009-16) | |
| 207Q00000X Family Medicine (Licence: OR DO175031) | |
| 207Q00000X Family Medicine (Licence: WA OP60610276) | |
| 207Q00000X Family Medicine (Licence: AK 114581) | |
| 207Q00000X Family Medicine (Licence: HI DOS-1793) | |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2019-09-10 |