| NPI | 1295862712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101231506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD039342) |
| 207Q00000X Family Medicine (Licence: MD D0071547) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2021-12-29 |