| NPI | 1790340388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD210002639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0028739) |
| 207Q00000X Family Medicine (Licence: MD D0100843) | |
| 207Q00000X Family Medicine (Licence: VA 0101275629) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2026-08-27 |