| NPI | 1386757482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101032806) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: DC MD039356) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-08-24 |