| NPI | 1831534957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-00634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 324917) |
| 207Q00000X Family Medicine (Licence: AL 40973) | |
| 207Q00000X Family Medicine (Licence: KS 04-43398) | |
| 207Q00000X Family Medicine (Licence: MS 27840) | |
| 207Q00000X Family Medicine (Licence: MI 4301503775) | |
| 207Q00000X Family Medicine (Licence: WI 2401320) | |
| 207Q00000X Family Medicine (Licence: CO CDR0002244) | |
| 207Q00000X Family Medicine (Licence: SC 82455) | |
| 207Q00000X Family Medicine (Licence: NY 299937) | |
| 207Q00000X Family Medicine (Licence: FL ME141592) | |
| 207Q00000X Family Medicine (Licence: CA A172294) | |
| 207Q00000X Family Medicine (Licence: GA 89618) | |
| 207Q00000X Family Medicine (Licence: OH 35128627) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2023-02-14 |