| NPI | 1124006804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D-30791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD14403) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |