| NPI | 1770624595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-41901) |
| 207Q00000X Family Medicine (Licence: GA 82314) | |
| 207Q00000X Family Medicine (Licence: WI 52-321) | |
| 207Q00000X Family Medicine (Licence: WV 3394) | |
| 207Q00000X Family Medicine (Licence: CA 20A9729) | |
| 207Q00000X Family Medicine (Licence: FL OS15828) | |
| 207Q00000X Family Medicine (Licence: TX S0543) | |
| 207Q00000X Family Medicine (Licence: AZ 007964) | |
| 207Q00000X Family Medicine (Licence: MN 65048) | |
| 207Q00000X Family Medicine (Licence: NY 298086) | |
| 207Q00000X Family Medicine (Licence: IL 036148831) | |
| 207Q00000X Family Medicine (Licence: VA 0102205607) | |
| 207Q00000X Family Medicine (Licence: IN 02005666A) | |
| 207Q00000X Family Medicine (Licence: NC 2019-00471) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-07-02 |