| NPI | 1811091366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101235379) |
| 207Q00000X Family Medicine (Licence: CA A88536) | |
| 207Q00000X Family Medicine (Licence: WA MD00044339) | |
| 207Q00000X Family Medicine (Licence: HI 13647) | |
| 207Q00000X Family Medicine (Licence: PA MD423174) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2015-10-21 |