| NPI | 1003987629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0009162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD25644) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |