| NPI | 1639266125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 320623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 96718) |
| 207Q00000X Family Medicine (Licence: MN 45499) | |
| 207Q00000X Family Medicine (Licence: GA 050856) | |
| 207Q00000X Family Medicine (Licence: HI MD - 11932) | |
| 207Q00000X Family Medicine (Licence: PA MD073815L) | |
| 207Q00000X Family Medicine (Licence: IL 336-067050) | |
| 207Q00000X Family Medicine (Licence: MD D0062163) | |
| 207Q00000X Family Medicine (Licence: SC 22708) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-03-06 |