| NPI | 1669785770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 74304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD041226) |
| 207Q00000X Family Medicine (Licence: FL ME129376) | |
| 207Q00000X Family Medicine (Licence: MD D0075725) | |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2024-11-13 |