| NPI | 1790135358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA OS018948) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 302466) |
| 208D00000X General Practice (Licence: CO DR.0063013) | |
| 208D00000X General Practice (Licence: MO 2020003560) | |
| 208D00000X General Practice (Licence: AL SP.243) | |
| 208D00000X General Practice (Licence: VT 032.0133783) | |
| 208D00000X General Practice (Licence: ME DO2764) | |
| 208D00000X General Practice (Licence: WV ITRDO-008) | |
| 208D00000X General Practice (Licence: MI 5101022520) | |
| 208D00000X General Practice (Licence: FL OS15642) | |
| 208D00000X General Practice (Licence: GA 847321) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-04-06 |