| 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 |