| NPI | 1104006360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D71264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD039026) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2017-02-13 |