| NPI | 1720374291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA LA312420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD042466) |
| 207Q00000X Family Medicine (Licence: VA 0116023741) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-11-03 |