| NPI | 1235231192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1570) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 1570) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2009-10-06 |