| NPI | 1932132883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A78791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0062489) |
| 207Q00000X Family Medicine (Licence: DC MD034950) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-12-13 |