| NPI | 1891063020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD444630) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: PA MD444630) |
| 208D00000X General Practice (Licence: AZ 45712) | |
| 208D00000X General Practice (Licence: FL ME124598) | |
| 208D00000X General Practice (Licence: MI 4301100744) | |
| 208D00000X General Practice (Licence: UT 8196317-1205) | |
| 208D00000X General Practice (Licence: VA 0101252052) | |
| 208D00000X General Practice (Licence: OH 35.125025) | |
| 208D00000X General Practice (Licence: NY 268257) | |
| 208D00000X General Practice (Licence: WA MD60267437) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2017-10-09 |