| NPI | 1841228947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC cs0112180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101263962) |
| 207Q00000X Family Medicine (Licence: WV 29364) | |
| 207Q00000X Family Medicine (Licence: MO 2018032594) | |
| 207Q00000X Family Medicine (Licence: MA 277082) | |
| 207Q00000X Family Medicine (Licence: MD M49221) | |
| 207Q00000X Family Medicine (Licence: IN 01079991B) | |
| 207Q00000X Family Medicine (Licence: MI 5135091205) | |
| 207Q00000X Family Medicine (Licence: AK 133474) | |
| 207Q00000X Family Medicine (Licence: FL ME133323) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2025-01-30 |