| NPI | 1306998406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101243402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00017070) |
| 207Q00000X Family Medicine (Licence: MD D0071387) | |
| 207Q00000X Family Medicine (Licence: DC MD039385) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2011-11-22 |