| NPI | 1922280601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 15542) |
| 207Q00000X Family Medicine (Licence: MS 25026) | |
| 207Q00000X Family Medicine (Licence: IL 036142890) | |
| 207Q00000X Family Medicine (Licence: KY C0883) | |
| 207Q00000X Family Medicine (Licence: MN 61777) | |
| 207Q00000X Family Medicine (Licence: TX N4488) | |
| 207Q00000X Family Medicine (Licence: WI 67626-21) | |
| 207Q00000X Family Medicine (Licence: MO 2017000003) | |
| 207Q00000X Family Medicine (Licence: OK 6120) | |
| 207Q00000X Family Medicine (Licence: NY 314367) | |
| 207Q00000X Family Medicine (Licence: IA DO-06140) | |
| 207Q00000X Family Medicine (Licence: CO CDR.0001926) | |
| 207Q00000X Family Medicine (Licence: TN 4941) | |
| 207Q00000X Family Medicine (Licence: AZ 009909) | |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2023-12-21 |