| NPI | 1811208044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A140152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 75604) |
| 207Q00000X Family Medicine (Licence: DC MD041555) | |
| 207Q00000X Family Medicine (Licence: MD D76369) | |
| 207Q00000X Family Medicine (Licence: NY 282096) | |
| 207Q00000X Family Medicine (Licence: OH 35.127839) | |
| 207Q00000X Family Medicine (Licence: MI 4301108699) | |
| 207Q00000X Family Medicine (Licence: FL ME126668) | |
| 207Q00000X Family Medicine (Licence: PA MD456231) | |
| 207Q00000X Family Medicine (Licence: WA 60596911) | |
| 207Q00000X Family Medicine (Licence: IL 36140348) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2019-10-14 |