| NPI | 1407261704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D83402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD045617) |
| 207Q00000X Family Medicine (Licence: VA 0101263114) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2021-12-03 |