| NPI | 1720222086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN 13465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-02165) |
| 207Q00000X Family Medicine (Licence: SC 81546) | |
| 207Q00000X Family Medicine (Licence: IN 01081118A) | |
| 207Q00000X Family Medicine (Licence: DC MD046613) | |
| 207Q00000X Family Medicine (Licence: VA 0101265910) | |
| 207Q00000X Family Medicine (Licence: FL ME108244) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2020-03-09 |