| NPI | 1760446686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1312) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 1312) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2017-08-24 |