| NPI | 1730346644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD039844) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2018-10-02 |