| NPI | 1275647430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD500003459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200500210) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2026-07-08 |