| NPI | 1376535096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 20931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV BA8133655) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-01-03 |