| NPI | 1720399280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 10776) |
| 207Q00000X Family Medicine (Licence: ID OC-0010) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-61129) | |
| 207Q00000X Family Medicine (Licence: MS 25516) | |
| 207Q00000X Family Medicine (Licence: WA OP60826527) | |
| 207Q00000X Family Medicine (Licence: KS 05-40628) | |
| 207Q00000X Family Medicine (Licence: NV CL0017) | |
| 207Q00000X Family Medicine (Licence: MN 63228) | |
| 207Q00000X Family Medicine (Licence: IA DO-05136) | |
| 207Q00000X Family Medicine (Licence: UT 10663123-1204) | |
| 207Q00000X Family Medicine (Licence: NE 1772) | |
| 207Q00000X Family Medicine (Licence: AL DO.1788) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0000063) | |
| 207Q00000X Family Medicine (Licence: WI 13-321) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2019-10-23 |