| NPI | 1982869814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 87582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD043586) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2021-07-02 |