| NPI | 1639275332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0078630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 20683) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-04-01 |