| NPI | 1720170285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD25805) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: DC MD25805) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2017-02-23 |