| NPI | 1649247313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD600004584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 13665) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2025-08-27 |