| NPI | 1275504938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101266309) |
| 207Q00000X Family Medicine (Licence: AR E11917) | |
| 207Q00000X Family Medicine (Licence: DC MD046744) | |
| 207Q00000X Family Medicine (Licence: FL ME138605) | |
| 207Q00000X Family Medicine (Licence: SC 40131) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-05-10 |