| NPI | 1750600896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 24906) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 24906) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2022-04-06 |