| NPI | 1639311509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301094339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C151483) |
| 207Q00000X Family Medicine (Licence: DE C1-0012997) | |
| 207Q00000X Family Medicine (Licence: WI 66675) | |
| 207Q00000X Family Medicine (Licence: DC MD046976) | |
| 207Q00000X Family Medicine (Licence: NY 289619) | |
| 207Q00000X Family Medicine (Licence: OH 35.129936) | |
| 207Q00000X Family Medicine (Licence: GA 77333) | |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2022-02-04 |