| NPI | 1235133562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 13276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 13276) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-01-08 |