| NPI | 1700964491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A66821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME126804) |
| 207Q00000X Family Medicine (Licence: AZ 51344) | |
| 207Q00000X Family Medicine (Licence: MI 4301108700) | |
| 207Q00000X Family Medicine (Licence: WA 60596936) | |
| 207Q00000X Family Medicine (Licence: PA MD456393) | |
| 207Q00000X Family Medicine (Licence: NY 281822) | |
| 207Q00000X Family Medicine (Licence: GA 75445) | |
| 207Q00000X Family Medicine (Licence: IL 36139663) | |
| 207Q00000X Family Medicine (Licence: MN 60077) | |
| 207Q00000X Family Medicine (Licence: OH 35.127997) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-04-21 |