| NPI | 1134367816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9501408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD14173) |
| 207Q00000X Family Medicine (Licence: MD D0029947) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-02-03 |