| NPI | 1215386966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 28661) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 28661) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2022-09-19 |