| NPI | 1154771939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD047874) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2021-04-15 |