| NPI | 1245490135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 306222) |
| 207Q00000X Family Medicine (Licence: MD D0082078) | |
| 207Q00000X Family Medicine (Licence: DC MD047695) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-09-28 |