| NPI | 1760550172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0057518) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD33361) |
| 207Q00000X Family Medicine (Licence: VA 0101059013) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-05-27 |