| NPI | 1730524877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD044582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D82139) |
| 207Q00000X Family Medicine (Licence: VA 0101261139) | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-06-07 |