| NPI | 1144221714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV WV14444) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 14444) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-09-15 |