| NPI | 1730108788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D30583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD11962) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-07-21 |