| NPI | 1811058951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0030484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD14489) |
| 207Q00000X Family Medicine (Licence: VA 0101035615) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2019-12-11 |