| NPI | 1881150035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3734) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 3734) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2022-10-25 |