| NPI | 1194940866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0037186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD17137) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2016-12-15 |