| NPI | 1033559695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD044148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025888) |
| 207Q00000X Family Medicine (Licence: MD D0088802) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2023-02-06 |