| NPI | 1245490135 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD047695) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 306222) | 
| 207Q00000X Family Medicine (Licence: VA 0101248472) | |
| 207Q00000X Family Medicine (Licence: MD D0082078) | |
| Enumeration Date | 2008-06-13 | 
| Last Update Date | 2025-08-30 |