| NPI | 1649498080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11410) |
| 207Q00000X Family Medicine (Licence: AZ 007768) | |
| 207Q00000X Family Medicine (Licence: IA DO-05251) | |
| 207Q00000X Family Medicine (Licence: IL 036147010) | |
| 207Q00000X Family Medicine (Licence: MN 64331) | |
| 207Q00000X Family Medicine (Licence: NE 1868) | |
| 207Q00000X Family Medicine (Licence: NH 19103) | |
| 207Q00000X Family Medicine (Licence: WI 31-321) | |
| 207Q00000X Family Medicine (Licence: KS 05-41277) | |
| 207Q00000X Family Medicine (Licence: NC 2018-02840) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2019-08-09 |