| NPI | 1831695451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35C.001517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR0062867) |
| 207Q00000X Family Medicine (Licence: WA IMLC.MD.61552720) | |
| 207Q00000X Family Medicine (Licence: AZ 73665) | |
| 207Q00000X Family Medicine (Licence: TX V0597) | |
| 207Q00000X Family Medicine (Licence: OK 45899) | |
| 207Q00000X Family Medicine (Licence: NV 25577) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-10-30 |