| NPI | 1972641926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 51937) |
| 207Q00000X Family Medicine (Licence: NC 2018-01137) | |
| 207Q00000X Family Medicine (Licence: IN 02005386A) | |
| 207Q00000X Family Medicine (Licence: TX R8507) | |
| 207Q00000X Family Medicine (Licence: DC DO034759) | |
| 207Q00000X Family Medicine (Licence: VA 0102201899) | |
| 208D00000X General Practice (Licence: VA 0102201899) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2019-10-22 |