| NPI | 1770576639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 58447) |
| 207Q00000X Family Medicine (Licence: OH 35.134809) | |
| 207Q00000X Family Medicine (Licence: CA C158291) | |
| 207Q00000X Family Medicine (Licence: KY 51814) | |
| 207Q00000X Family Medicine (Licence: TN 58165) | |
| 207Q00000X Family Medicine (Licence: DE C1-0012892) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2019-09-11 |