| NPI | 1477712255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0069141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242295) |
| 207Q00000X Family Medicine (Licence: DC MD037028) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2015-10-06 |