| NPI | 1235468968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0074927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD040754) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DC MD040754) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2023-08-16 |