| NPI | 1679869952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 26295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9303) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2022-07-21 |