| NPI | 1356409338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D52743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD30475) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-09-01 |