| NPI | 1275950396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H83783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD045539) |
| 207Q00000X Family Medicine (Licence: VA 0102205000) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2021-06-20 |