| NPI | 1316117815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2262) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 2262) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WV 2262) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2022-06-08 |