| NPI | 1598896268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 83059) |
| 207Q00000X Family Medicine (Licence: TX S2095) | |
| 207Q00000X Family Medicine (Licence: OH 34.014374) | |
| 207Q00000X Family Medicine (Licence: AR E-12038) | |
| 207Q00000X Family Medicine (Licence: TN 3657) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-02-28 |