| NPI | 1699983858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0070798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD040210) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2023-05-17 |