| NPI | 1770710451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD DO82252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN FN 318354) |
| 207Q00000X Family Medicine (Licence: DC MD044683) | |
| 207Q00000X Family Medicine (Licence: VA 0101261281) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2021-06-24 |