| NPI | 1215950605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD500002435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070761) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-12-05 |