| NPI | 1952760977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 50-004574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 085.009636) |
| 207Q00000X Family Medicine (Licence: FL PA9117554) | |
| 207Q00000X Family Medicine (Licence: NY 031184) | |
| 207Q00000X Family Medicine (Licence: PA MA064513) | |
| 207Q00000X Family Medicine (Licence: UT 14105581-1206) | |
| 207Q00000X Family Medicine (Licence: MA PA100966) | |
| 207Q00000X Family Medicine (Licence: NV PA3088) | |
| 207Q00000X Family Medicine (Licence: CA PA64459) | |
| 207Q00000X Family Medicine (Licence: CO PA.0008758) | |
| 207Q00000X Family Medicine (Licence: GA 12665) | |
| 207Q00000X Family Medicine (Licence: CT 6845) | |
| 207Q00000X Family Medicine (Licence: TX PA18526) | |
| 207Q00000X Family Medicine (Licence: NJ 25MP00898400) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2025-08-04 |