| NPI | 1346544160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WV ED1222) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007262) |
| Enumeration Date | 2011-01-08 |
| Last Update Date | 2023-06-22 |