| NPI | 1083879035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD038484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003453) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2011-12-01 |