| NPI | 1700902046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC md036177) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-01-11 |