| NPI | 1407032485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0064592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD036021) |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2018-07-30 |