| NPI | 1619401874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35142950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD048248) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-10-21 |