| NPI | 1760479133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 13986) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 13986) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2022-04-06 |