| NPI | 1194010678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D83130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD044945) |
| 207Q00000X Family Medicine (Licence: VA 0101262023) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2021-06-10 |