| NPI | 1184689895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0047609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD16758) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-05-07 |