| NPI | 1679011647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: PA OS019522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2021-01198) |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-95803) | |
| 207Q00000X Family Medicine (Licence: PA OT017560) | |
| 207Q00000X Family Medicine (Licence: VA 0102206808) | |
| 207Q00000X Family Medicine (Licence: PA OS019522) | |
| 207Q00000X Family Medicine (Licence: CA 20A23962) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: CA 20A23962) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: VA 0102206808) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: NC 2021-01198) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: MT MED-PHYS-LIC-95803) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2025-04-21 |