| NPI | 1740290139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0061140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD040205) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-08-18 |