| NPI | 1659535557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO000001897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA DO465) |
| 207Q00000X Family Medicine (Licence: AL 2612) | |
| 207Q00000X Family Medicine (Licence: TX T1580) | |
| 207Q00000X Family Medicine (Licence: NV cl0424) | |
| 207Q00000X Family Medicine (Licence: MN 69736) | |
| 207Q00000X Family Medicine (Licence: NC 245554) | |
| 207Q00000X Family Medicine (Licence: GA 89414) | |
| 207Q00000X Family Medicine (Licence: AZ 009282) | |
| 207Q00000X Family Medicine (Licence: WI 1079) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0003065) | |
| 207Q00000X Family Medicine (Licence: NE 2554) | |
| 207Q00000X Family Medicine (Licence: MI EMC0001164) | |
| 207Q00000X Family Medicine (Licence: MS 24616) | |
| 207Q00000X Family Medicine (Licence: CA 18920) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2026-04-14 |