| NPI | 1851395834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 17682) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 17682) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2019-04-10 |