| NPI | 1780983569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 46956) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE c1-0024077) |
| 208D00000X General Practice (Licence: ID mc-0725) | |
| 207P00000X Emergency Medicine (Licence: OK 37429) | |
| 207P00000X Emergency Medicine (Licence: IN 01073793A) | |
| 208D00000X General Practice (Licence: SC 84940) | |
| 208D00000X General Practice (Licence: NV 20451) | |
| 208D00000X General Practice (Licence: WV 30133) | |
| 208D00000X General Practice (Licence: WY 13120c) | |
| 208D00000X General Practice (Licence: MS 28281) | |
| 207Q00000X Family Medicine (Licence: WI 1038) | |
| 208D00000X General Practice (Licence: CO dr.0065155) | |
| 207P00000X Emergency Medicine (Licence: FL ME146686) | |
| 208D00000X General Practice (Licence: SD 12317) | |
| 208D00000X General Practice (Licence: NJ 25MA10949500) | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2025-09-03 |