| NPI | 1750876876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 312279-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-3616) |
| 207Q00000X Family Medicine (Licence: DE C1-0024382) | |
| 207Q00000X Family Medicine (Licence: GA 89317) | |
| 207Q00000X Family Medicine (Licence: IN 01086220A) | |
| 207Q00000X Family Medicine (Licence: NM MD2021-0732) | |
| 207Q00000X Family Medicine (Licence: PA MD475546) | |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2021-09-05 |