| NPI | 1922035450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 39497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD 035624) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-04-25 |