| NPI | 1508825613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D31674) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 25160) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2022-08-03 |