| NPI | 1649684465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC DO034689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027094) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2018-03-17 |