| NPI | 1891991667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00048500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 273253) |
| 207Q00000X Family Medicine (Licence: CO CDR.0000270) | |
| 207Q00000X Family Medicine (Licence: OR MD181573) | |
| 207Q00000X Family Medicine (Licence: RI MD16339) | |
| 207Q00000X Family Medicine (Licence: AZ 57848) | |
| 207Q00000X Family Medicine (Licence: CA C165204) | |
| 207Q00000X Family Medicine (Licence: AL MD.37731) | |
| 207Q00000X Family Medicine (Licence: WI 317-320) | |
| 207Q00000X Family Medicine (Licence: NV 18525) | |
| 207Q00000X Family Medicine (Licence: IA MD-45832) | |
| 207Q00000X Family Medicine (Licence: MN 64885) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD00048500) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2021-04-05 |