| NPI | 1871708750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 312268) |
| 207Q00000X Family Medicine (Licence: IN 02005613A) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-76347) | |
| 207Q00000X Family Medicine (Licence: UT 11242844-1204) | |
| 207Q00000X Family Medicine (Licence: WA OP60919233) | |
| 207Q00000X Family Medicine (Licence: IA DO-05332) | |
| 207Q00000X Family Medicine (Licence: AK 144252) | |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2023-09-08 |