| NPI | 1003101973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD046712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 248446) |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2019-08-20 |