| NPI | 1841225554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 237999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS018488) |
| 207Q00000X Family Medicine (Licence: SC 28-83791) | |
| 207Q00000X Family Medicine (Licence: OH 34.017812) | |
| 207Q00000X Family Medicine (Licence: MI 5101028427) | |
| 207Q00000X Family Medicine (Licence: NC 2021-03386) | |
| 207Q00000X Family Medicine (Licence: IN 02008525A) | |
| 207Q00000X Family Medicine (Licence: GA 91055) | |
| 207Q00000X Family Medicine (Licence: MD H0086274) | |
| 207Q00000X Family Medicine (Licence: WI 82001-21) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-10-10 |