| NPI | 1033316781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 23075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0075589) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-03-04 |