| NPI | 1790945624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD041699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0076410) |
| 207Q00000X Family Medicine (Licence: VA 0116020092) | |
| 207Q00000X Family Medicine (Licence: NY 303911) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2024-06-25 |