| 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 |