| NPI | 1013361054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0087782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101265986) |
| 207Q00000X Family Medicine (Licence: DC MD047239) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2020-09-17 |