| NPI | 1972611051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0037617) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: DC MD19758) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2023-03-07 |