NPI | 1740404375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WV 23889) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 23889) |
Enumeration Date | 2007-04-13 |
Last Update Date | 2024-09-19 |