| NPI | 1629338470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 17981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284778) |
| 207Q00000X Family Medicine (Licence: ID M-14141) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-60886) | |
| 207Q00000X Family Medicine (Licence: CA A143337) | |
| 207Q00000X Family Medicine (Licence: CO DR.0059780) | |
| 207Q00000X Family Medicine (Licence: WA MD60818224) | |
| 207Q00000X Family Medicine (Licence: OR MD186008) | |
| 207Q00000X Family Medicine (Licence: NM MD2018-0164) | |
| 207Q00000X Family Medicine (Licence: NV 17828) | |
| 207Q00000X Family Medicine (Licence: WY 11453A) | |
| 207Q00000X Family Medicine (Licence: AZ 55553) | |
| 207Q00000X Family Medicine (Licence: TX S2376) | |
| 207Q00000X Family Medicine (Licence: FL ME142837) | |
| 207Q00000X Family Medicine (Licence: IL 036151000) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2020-01-13 |