| NPI | 1366588535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D80061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2006-00361) |
| 207Q00000X Family Medicine (Licence: DC MD036513) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2018-03-17 |