| NPI | 1467766782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD500002701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60359436) |
| 207Q00000X Family Medicine (Licence: NY 288933) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2025-01-06 |