| NPI | 1841287679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 39821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 80607) |
| 207Q00000X Family Medicine (Licence: FL ME137348) | |
| 207Q00000X Family Medicine (Licence: AR E-11497) | |
| 207Q00000X Family Medicine (Licence: KY 52136) | |
| 207Q00000X Family Medicine (Licence: VA 0101265646) | |
| 207Q00000X Family Medicine (Licence: OH 35.134060) | |
| 207Q00000X Family Medicine (Licence: MI 4301114941) | |
| 207Q00000X Family Medicine (Licence: MD D0085354) | |
| 207Q00000X Family Medicine (Licence: TN 58776) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2019-12-18 |