| NPI | 1609843960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 20707) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WV 20707) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2022-07-21 |