| NPI | 1780748822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101058211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD32709) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2022-11-14 |