| NPI | 1902144512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD455879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-16741) |
| 207Q00000X Family Medicine (Licence: AL 46215) | |
| 207Q00000X Family Medicine (Licence: AK 207870) | |
| 207Q00000X Family Medicine (Licence: DE C1-0026012) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0002656) | |
| 207Q00000X Family Medicine (Licence: CA C184112) | |
| 207Q00000X Family Medicine (Licence: CT 074004) | |
| 207Q00000X Family Medicine (Licence: DC MD210011928) | |
| 207Q00000X Family Medicine (Licence: AZ 67578) | |
| 207Q00000X Family Medicine (Licence: LA 333693) | |
| 208M00000X Hospitalist (Licence: PA MD455879) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD455879) | |
| 208000000X Pediatrics (Licence: PA MD455879) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 2023-00319) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2025-04-30 |