| NPI | 1649581075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 007890) |
| Additional Taxonomies | 202K00000X (Licence: FL OS19719) |
| 202K00000X (Licence: AZ 007890) | |
| 207Q00000X Family Medicine (Licence: FL OS19719) | |
| 207Q00000X Family Medicine (Licence: OR DO161777) | |
| 208D00000X General Practice (Licence: WY 9061A) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2023-06-21 |