| NPI | 1104119056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 205915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0078134) |
| 207Q00000X Family Medicine (Licence: DC MD042455) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2021-08-18 |