| NPI | 1376542290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 19776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35076392) |
| 207P00000X Emergency Medicine (Licence: WV 19776) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2023-03-07 |