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 |