| NPI | 1851407142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV ED0222A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00965) |
| 207Q00000X Family Medicine (Licence: WV 2635) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2014-09-11 |