NPI | 1508943192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101233448) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD039616) |
207Q00000X Family Medicine (Licence: MD D0071559) | |
Enumeration Date | 2006-11-01 |
Last Update Date | 2021-05-28 |