| NPI | 1134230311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS10096) |
| 207Q00000X Family Medicine (Licence: OH 34.010454) | |
| 207Q00000X Family Medicine (Licence: NC 2012-01177) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-08-03 |