| NPI | 1770813057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD034993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101236495) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |