| NPI | 1912982273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101038598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD14687) |
| 207Q00000X Family Medicine (Licence: MD D0031326) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-02-08 |