| NPI | 1598962193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 23383) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101267025) |
| 207Q00000X Family Medicine (Licence: VA 0101267025) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2023-03-07 |