| NPI | 1285808048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 202102956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 24127) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2023-03-02 |