| NPI | 1851426092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25412) |
| 207Q00000X Family Medicine (Licence: DC MD042218) | |
| 207Q00000X Family Medicine (Licence: AZ 38110) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2021-10-07 |