NPI | 1669785770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0075725) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD041226) |
207Q00000X Family Medicine (Licence: FL ME129376) | |
Enumeration Date | 2010-07-17 |
Last Update Date | 2020-05-07 |