| NPI | 1083956445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME143614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD500001806) |
| 207Q00000X Family Medicine (Licence: MD D0098740) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2024-10-04 |