| NPI | 1710132485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101244061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D72861) |
| 207Q00000X Family Medicine (Licence: DC MD037407) | |
| Enumeration Date | 2008-11-22 |
| Last Update Date | 2021-05-27 |