| NPI | 1538261193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 10408) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV 10408) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2020-06-04 |