| NPI | 1659378198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0036186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101042011) |
| 207Q00000X Family Medicine (Licence: DC MD14879) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2008-11-12 |