| NPI | 1477614998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D58436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD33497) |
| 207Q00000X Family Medicine (Licence: VA 0101232466) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |