| NPI | 1326149469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0062868) |
| 207Q00000X Family Medicine (Licence: DC MD035401) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-01-31 |