| NPI | 1427362383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: WV 25370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09179900) |
| 207Q00000X Family Medicine (Licence: PA MD448069) | |
| 207Q00000X Family Medicine (Licence: WV 25370) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2024-01-16 |