| NPI | 1881220846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A21465) |
| 207Q00000X Family Medicine (Licence: FL UO7323) | |
| 207Q00000X Family Medicine (Licence: TX U1726) | |
| 207Q00000X Family Medicine (Licence: AZ 010271) | |
| 207Q00000X Family Medicine (Licence: MI 5101027533) | |
| 207Q00000X Family Medicine (Licence: IL 036.163210) | |
| 207Q00000X Family Medicine (Licence: IN 02007274A) | |
| 207Q00000X Family Medicine (Licence: MN 75137) | |
| 207Q00000X Family Medicine (Licence: NY 321249) | |
| 207Q00000X Family Medicine (Licence: WI 81082-21) | |
| 207Q00000X Family Medicine (Licence: OH 34C.000162) | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2023-08-31 |