| NPI | 1073593885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101249245) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 22062) |
| 207Q00000X Family Medicine (Licence: WV 22062) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2024-07-16 |