| NPI | 1477873941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 25161) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: WV 25161) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2023-10-09 |