| NPI | 1104929462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101255878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0066720) |
| 207Q00000X Family Medicine (Licence: DC MD042074) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2014-06-11 |