| NPI | 1841603750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.143568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 11867C) |
| 207Q00000X Family Medicine (Licence: AZ 57735) | |
| 207Q00000X Family Medicine (Licence: WA MD60917707) | |
| 207Q00000X Family Medicine (Licence: KS 04-41701) | |
| 207Q00000X Family Medicine (Licence: WI 301-320) | |
| 207Q00000X Family Medicine (Licence: MN 64809) | |
| 207Q00000X Family Medicine (Licence: IA MD-45781) | |
| 207Q00000X Family Medicine (Licence: NE 31322) | |
| 207Q00000X Family Medicine (Licence: UT 11066881-1205) | |
| 207Q00000X Family Medicine (Licence: SD 11277) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036.143568) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-01-18 |